UnitedHealthcare, OU Health contract dispute

Transplant surgeon Oya Andacoglu, MD, a member of OU Health Physicians, speaks with a patient. Recently, OU Health was excluded from the network with UnitedHealthcare because the insurance provider wanted to reduce the fees paid to doctors and facilities. (Photo courtesy of OU Health)

OKLAHOMA CITY – OU Negotiations between health insurance provider and UnitedHealthcare provider have created a dilemma for some of the state’s most seriously ill patients.

Despite a five-month hiatus, the two sides say they have never been close to reaching an agreement on a new contract.

OU Health called for rate hikes to offset the rising costs of caring for patients, while UHC wanted to cut rates by 39% for doctors and pay 20% for facilities.

As a result, the OU Health System was left out of the network with UHC on May 1st.

“It is gratifying that UnitedHealthcare has proposed such drastic cuts to our contract,” said Richard Lofgren, MD, president and CEO of OU Health. Further restricting access to the special and advanced specialties and subspecialties that OU Health offers to the region. “

OU Health said the recent rate hike proposed in April was lower than the current inflation rate.

UHC spokesman Spencer Leuning said OU Health had initially requested a 40% price increase over three years, or nearly $ 49 million over the duration of the contract. His latest proposal – a one-year contract – would be 34% more expensive than other Oklahoma City hospitals, he said.

UHC stated on its website that members can choose from 15 online hospitals around Oklahoma City, as well as many primary care physicians and specialists.

But OU Health offers some types of care that are not available anywhere else in the state, said Robert Mannel, MD, director of the OU Health Stephenson Cancer Center. To receive the same quality of care or comprehensive services for children, patients would have to travel to Texas, he said.

“It’s clear that we have a lot of weight on our minds right now,” Mannel said.

The Stephenson Cancer Center asked for a three-month extension of coverage for 522 patients to schedule treatment at another facility, but only a third received a response, all of which were for one-day office visits, Mannel said.

“You can’t stop chemotherapy. “We can’t stop the radiation without harm,” he said.

Mannel said 20% of patients at the Stephenson Cancer Center are participating in clinical trials for drugs that cannot be found anywhere else in Oklahoma, and one in 12 patients has UHC insurance.

A man who was diagnosed with fourth-stage colon cancer more than three years ago and was told to live for five weeks was enrolled in a clinical trial and responded.

“He’s alive today, enjoying his family and enjoying his life,” Mannel said. “It’s just multiplied by a hundred and I’m working on that right now.”

COVID-19 has led to rising staff costs, rising healthcare costs, and “significant increases in the cost of doing business.”

Needless to say, the patients come with more advanced stages of cancer after skipping regular performances during the pandemic, he said.

All things considered, Mannel said it was unrealistic for the UHC to propose such “draconian reductions,” especially at a time when profits have been record highs.2021 ending with $ 17.3 billion in profits.

Last year, OU Health renegotiated the contract with Blue Cross and Blue Shield of Oklahoma and was able to reach a three-year deal, he said.

“We still hope that United will back down and reconsider,” Mannel said. Patients should tell their company that they are disappointed, and employers should report to UnitedHealthcare, he said.

The UHC stated: “Our top priority is to renew our relationship with the health care system at competitive market prices so that our members have access to affordable health care.”

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